External Validation of European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) for Risk Prioritization in an Iranian Population

<div><p>Abstract Introduction: The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is a prediction model which maps 18 predictors to a 30-day post-operative risk of death concentrating on accurate stratification of candidate patients for cardiac surgery. Objective: The objective of this study was to determine the performance of the EuroSCORE II risk-analysis predictions among patients who underwent heart surgeries in one area of Iran. Methods: A retrospective cohort study was conducted to collect the required variables for all consecutive patients who underwent heart surgeries at Emam Reza hospital, Northeast Iran between 2014 and 2015. Univariate and multivariate analysis were performed to identify covariates which significantly contribute to higher EuroSCORE II in our population. External validation was performed by comparing the real and expected mortality using area under the receiver operating characteristic curve (AUC) for discrimination assessment. Also, Brier Score and Hosmer-Lemeshow goodness-of-fit test were used to show the overall performance and calibration level, respectively. Results: Two thousand five hundred eight one (59.6% males) were included. The observed mortality rate was 3.3%, but EuroSCORE II had a prediction of 4.7%. Although the overall performance was acceptable (Brier score=0.047), the model showed poor discriminatory power by AUC=0.667 (sensitivity=61.90, and specificity=66.24) and calibration (Hosmer-Lemeshow test, P<0.01). Conclusion: Our study showed that the EuroSCORE II discrimination power is less than optimal for outcome prediction and less accurate for resource allocation programs. It highlights the need for recalibration of this risk stratification tool aiming to improve post cardiac surgery outcome predictions in Iran.</p></div

Importance of population characteristics and comparative probabilities of the top six important classifiers for screening.

Importance of population characteristics and comparative probabilities of the top six important classifiers for screening.</p

Population characteristics in each step of the care cascade.

Population characteristics in each step of the care cascade.</p

Additional file 1 of Global, regional, and national burden and quality of care index (QCI) of oral disorders: a systematic analysis of the global burden of disease study 1990–2017

Additional file 1

Importance of population characteristics and comparative probabilities of the top six important classifiers for diagnosis.

Importance of population characteristics and comparative probabilities of the top six important classifiers for diagnosis.</p

Importance of population characteristics and comparative probabilities of the top six important classifiers for treatment.

Importance of population characteristics and comparative probabilities of the top six important classifiers for treatment.</p

Importance of population characteristics and comparative probabilities of the top six important classifiers for control.

Importance of population characteristics and comparative probabilities of the top six important classifiers for control.</p

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Table_2_Physical activity pattern in Iran: Findings from STEPS 2021.DOCX

BackgroundInsufficient physical activity (IPA) is a significant risk factor for various non-communicable diseases. The Iran action plan is a 20% reduction in IPA. Therefore, we aimed to describe the age and sex pattern of physical activity domains, IPA, the intensity of physical activity, sedentary behavior, and their associates at Iran's national and provincial levels in 2021.MethodsThis study used the data of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) 2021 in Iran. The STEPS study used the Global Physical Activity Questionnaire (GPAQ) version two developed by WHO for the assessment of physical activity, which included work, transport, and recreational activities domains. We showed and compared demographic and clinical characteristics of participants between males and females, using t-test and Chi-square test. A logistic regression model adjusted for residential areas, years of schooling, wealth index, age, marital status, and occupation has also been implemented. The results were presented as percentages and 95% confidence intervals (CI).ResultsWe included 27,874 participants with a mean (SD) age of 45.69 (15.91), among whom 12,479 (44.77%) were male. The mean prevalence of IPA for the whole population for all ages was 51.3% (50.62–51.98%). By sex, 41.93% (40.88–42.98%) and 57.87% (56.99–58.75%) of men and women had IPA, respectively. According to the physical activity domains, the age-standardized prevalence of no recreational activity was 79.40% (78.80–79.99%), no activity at work was 66.66% (65.99–67.32%), and no activity at transport was 49.40% (48.68–50.11%) for both sexes combined. Also, the overall age-standardized prevalence of sedentary behaviors was 50.82% (50.11–51.53%). Yazd province represented the highest prevalence of IPA (63.45%), while West Azerbaijan province represented the lowest prevalence (39.53%). Among both sexes, living in the urban area vs. rural area [adjusted OR: 1.44; (1.31–1.58)], married vs. single status [adjusted OR: 1.33; (1.16–1.53)], and wealth index of class 3 vs. class 1 [adjusted OR: 1.15; (1.01–1.30)] were significantly associated with a higher rate of IPA.ConclusionThe prevalence of IPA was considerably high in Iran. To achieve the predefined goal of reducing IPA, the health system should prioritize increasing physical activity, especially in urban areas and among females.</p

Image_2_Physical activity pattern in Iran: Findings from STEPS 2021.pdf

BackgroundInsufficient physical activity (IPA) is a significant risk factor for various non-communicable diseases. The Iran action plan is a 20% reduction in IPA. Therefore, we aimed to describe the age and sex pattern of physical activity domains, IPA, the intensity of physical activity, sedentary behavior, and their associates at Iran's national and provincial levels in 2021.MethodsThis study used the data of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) 2021 in Iran. The STEPS study used the Global Physical Activity Questionnaire (GPAQ) version two developed by WHO for the assessment of physical activity, which included work, transport, and recreational activities domains. We showed and compared demographic and clinical characteristics of participants between males and females, using t-test and Chi-square test. A logistic regression model adjusted for residential areas, years of schooling, wealth index, age, marital status, and occupation has also been implemented. The results were presented as percentages and 95% confidence intervals (CI).ResultsWe included 27,874 participants with a mean (SD) age of 45.69 (15.91), among whom 12,479 (44.77%) were male. The mean prevalence of IPA for the whole population for all ages was 51.3% (50.62–51.98%). By sex, 41.93% (40.88–42.98%) and 57.87% (56.99–58.75%) of men and women had IPA, respectively. According to the physical activity domains, the age-standardized prevalence of no recreational activity was 79.40% (78.80–79.99%), no activity at work was 66.66% (65.99–67.32%), and no activity at transport was 49.40% (48.68–50.11%) for both sexes combined. Also, the overall age-standardized prevalence of sedentary behaviors was 50.82% (50.11–51.53%). Yazd province represented the highest prevalence of IPA (63.45%), while West Azerbaijan province represented the lowest prevalence (39.53%). Among both sexes, living in the urban area vs. rural area [adjusted OR: 1.44; (1.31–1.58)], married vs. single status [adjusted OR: 1.33; (1.16–1.53)], and wealth index of class 3 vs. class 1 [adjusted OR: 1.15; (1.01–1.30)] were significantly associated with a higher rate of IPA.ConclusionThe prevalence of IPA was considerably high in Iran. To achieve the predefined goal of reducing IPA, the health system should prioritize increasing physical activity, especially in urban areas and among females.</p